title: Minimally invasive endoscopic management of subglottic stenosis in children: success and failure.
abstract: OBJECTIVE
  To assess the efficacy and safety of endoscopic management of subglottic stenosis both as a primary and as an adjunctive treatment in the pediatric population.
  
  
  METHODS
  Retrospective review of pediatric patients with subglottic stenosis undergoing endoscopic airway procedures at a tertiary care pediatric medical center. Outcomes were assessed by systematic review to determine the success and failure of the endoscopic approach.
  
  
  RESULTS
  Forty patients (22 male, 18 female) underwent endoscopic interventions for a diagnosis of subglottic airway stenosis between 2003 and 2006. Age ranged from 22 days old to 20 years old. Recorded degree of subglottic stenosis ranged from 10% to 99%. Fifty-three percent (21/40) had a history of prematurity, and 40% (16/40) had secondary airway diagnoses. Twenty-four patients underwent an endoscopic intervention initially (including laser or dilation, with or without topical mitomycin treatment), including four patients who underwent tracheostomy prior to the first endoscopic intervention. Sixteen underwent laryngotracheoplasty initially, including ten patients who underwent tracheostomy prior to the laryngotracheoplasty. Endoscopic treatment resulted in resolution of symptoms, and/or decannulation, and no further need for an open procedure in 58% of patients. Of the 24 patients undergoing endoscopic interventions initially, 14 patients underwent two or more endoscopic interventions, and 10 patients subsequently required tracheostomy or laryngotracheoplasty. When endoscopic procedures were used as an adjunct to laryngotracheoplasty, 60% (12/20) had resolution of symptoms, underwent decannulation, and did not require tracheostomy or revision laryngotracheoplasty.
  
  
  CONCLUSIONS
  The endoscopic approach can be successful in the management of properly selected patients with subglottic stenosis, either as the initial treatment modality or as an adjunctive treatment in cases of re-stenosis after open airway surgery. The likelihood of success with a minimally invasive procedure as the primary treatment decreases with worsening initial grade of subglottic stenosis.
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Quesnel
authors.forename: Gi Soo
authors.initials: GS
authors.lastname: Lee
authors.forename: Roger C
authors.initials: RC
authors.lastname: Nuss
authors.forename: Mark S
authors.initials: MS
authors.lastname: Volk
authors.forename: Dwight T
authors.initials: DT
authors.lastname: Jones
authors.forename: Reza
authors.initials: R
authors.lastname: Rahbar
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D058753:Laryngoplasty / Q000009:adverse effects / Q000379:methods; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods*; D007829:Laryngostenosis / Q000175:diagnosis / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult